Inspection on 25/07/07 for Avonwood Manor

This inspection was carried out on 25th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Avonwood Manor 08/12/09

Avonwood Manor 12/11/09

Avonwood Manor 20/10/09

Avonwood Manor 21/09/09

Avonwood Manor 17/06/09

Avonwood Manor 13/05/08

Avonwood Manor 25/04/06

Avonwood Manor 28/10/05

Avonwood Manor 25/05/05

Avonwood Manor 27/01/05

Avonwood Manor 16/04/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Avonwood Manor 31-33 Nelson Road Branksome Poole Dorset BH12 1ES Lead Inspector Martin Bayne Key Unannounced Inspection 25th July 2007 9:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avonwood Manor Address 31-33 Nelson Road Branksome Poole Dorset BH12 1ES 01202 763183 01202 751530 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Avonwood Manor Ltd Mrs Margaret Dorothy Ann Phillips Care Home 49 Category(ies) of Dementia - over 65 years of age (49), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (49) Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named person (as known to CSCI) under the age of 65 may be accommodated to receive care. 25th April 2006 Date of last inspection Brief Description of the Service: Avonwood Manor is registered to provided accommodation and personal care for up to 49 residents who suffer from mental health disorders or dementia above the age of 65. The home is owned by Avonwood Manor Ltd but is managed through agents, BML Healthcare Ltd. The home is situated in a quiet residential area close to the shops and amenities of Westbourne, and is made up of two large properties that have been joined by an extension. Each of the properties has three floors and there is a passenger lift at either end of the home. Communal areas are located on the ground floor and there are well-maintained gardens leading from the back of the home that the residents can access. The gardens are enclosed to ensure the safety of the residents. The majority of the bedrooms are for single occupancy with en-suite WC facilities, however there are eight double rooms, in which screens are provided for resident’s privacy. To the front of the home there is parking for staff and visitors. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the findings of the key inspection of Avonwood Manor Residential home that took place between 9am and 4:30 pm, the aim of which was to evaluate the home against the key National Minimum Standards for Older People. There were no requirements made at the last inspection. Time was spent with the Manager and Service Manager for the organisation discussing progress at the home. Various records were seen that provided evidence of the care and support offered to residents of the home. Time was spent in the communal area speaking to residents, staff and observing the interaction between staff and residents. A tour of the promises was also made. Comment cards were sent to 10 relatives, 6 care managers and to 6 health care professionals. What the service does well: The home has good assessment processes that ensure that needs of residents admitted to the home are met. Well-written care plans ensure that staff meet the assessed needs of residents. Recreational and leisure needs of residents are assessed and met. Relatives are kept informed and encouraged to maintain links with the home. The home maintains good recruitment practices. The home is kept in good repair and decorative order, providing a ‘homely’ atmosphere for the residents. The home is well managed. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from their needs being assessed prior to their being offered a place at the home. EVIDENCE: Time was initially spent discussing the Statement of Purpose and it was agreed that this would be reviewed and a copy sent to CSCI. A new certificate will be sent to the home following a review of the ‘Conditions’ on the certificate. The manager had returned the Annual Assurance Assessment form that provided details on the procedures for referrals and assessments of people interested in moving to the home. Following an enquiry, a brochure and a copy of the Service User Guide is sent out and the person or their relatives are Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 9 invited to view the home. Either the Registered Manager or the Deputy then carries out a pre-admission assessment to ensure that the needs of the person can be met at the home. Throughout the inspection a sample of three residents personal files was used to track the required paperwork that the home maintains on behalf of the residents. All three residents had been admitted to the home since the last key inspection in April 2006. It was found in all three cases, an assessment of need had been written up and provided details of needs under the topics prescribed in the National Minimum Standards. A letter had then been sent to the relatives of the person, (as all three did not have mental capacity and their admission was being arranged through relatives and care managers); to inform that needs could be met at the home. It was also found that the home had obtained a copy of the care management assessments and care plan. At the time of inspection a social worker and a family were visiting the home. They were conducted on a tour of the home and were given a copy of the brochure and the Service User Guide. The home does not provide an intermediate care service. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from their health and care needs being met through good care planning, however procedures for medication administration could be improved. EVIDENCE: The care plans for the three residents tracked through the inspection were seen. There was a photograph on the front of each file for easy recognition of the residents. Care plans were typed and provided concise information on how the individual assessed needs were to be met by the staff. Care plans had been written for meeting day care needs and also one written for nighttime care needs. The three residents tracked through the inspection did not have mental capacity to understand their plan and this was recorded. There was one plan where a relative had signed on behalf of a resident, demonstrating Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 11 that relatives are involved in the care planning process. Relatives are invited to help provide a social history and a form is sent to them when a person is admitted and also a form looking at end of life care and wishes in the event of death. For the three residents tracked through the inspection a social history form had been completed. In the case of one person there was a good example where the information about this person’s former career had contributed to meeting their social and recreational needs. It was found that the plans had been reviewed each month as required under the Standards. Returned comment cards also informed that health and social care needs were being met at the home. Linked to the care plans were risk assessments. These included, a moving and handling assessment and a chart identifying risks and how these may be reduced. In addition to care planning and risk assessments, the staff complete daily recording and there was good evidence form these notes that health needs of residents were being met with referrals to doctors being made appropriately. There was also recording within care plans about meeting other health needs such as chiropody and dentistry. The medication administration records for the Nelson building were seen. It was found that there were some gaps for medication given out on the morning of the inspection. This was discussed with the staff member who had administered the medication and with the manager. The procedure for the home is that medication should be individually administered and then the record completed. The staff member informed that they were called to assist with a resident’s personal care and that the records would have been corrected later. A requirement was made that medication is administered in line with the home’s policies and procedures and that the recording sheets are completed in full at the time that medicines are administered. Medications were found to be stored away correctly with the trolley being kept locked with the senior member of staff holding the key. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from their recreational and social needs being met and from being offered an appealing balanced diet. EVIDENCE: Time was spent in the lounges of Nelson and Selbourne units both observing and talking with residents. The home has an activities co-ordinator who was engaged with a group of residents playing a board game. A list of activities was seen on the residents’ notice board of the communal activities arranged for the week ahead. There was also a copy of a Newsletter produced by the staff to inform residents and relatives. Records are kept of activities and of the residents who participate. Activities for the week ahead included – music and movement, table top games, puzzles, skittles, arts and crafts, gardening, indoor golf, reminiscence. Those residents who do not join in communal activities are offered one to one time with staff to ensure that they are included. As mentioned earlier in the report there was evidence that Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 13 information concerning relevant social histories of residents gets incorporated in the care planning, which includes meeting recreational needs. In general comment cards informed that levels of activities arranged for residents was satisfactory. The staff were observed to interact well with residents and it appeared that the residents were comfortable and relaxed with the staff. The residents were all well groomed with attention paid to their personal appearance, being in clean clothes and attention paid to their hair and nails. The manager informed that a Church of England service is held in the home once a month and that should there be an assessed need other services would be arranged. Relatives are encouraged to be involved in the home and are welcome to visit at any time. They are also welcome to stay for meals, to take part in activities and to attend functions. The manager also informed that the home operates an open door policy and relatives can talk with managers whenever they feel a need. Every three months a residents and relatives’ meeting is held when issues about the home and the way it operates can be discussed. The menu of food for the day was displayed on the resident’s notice board in the lounge. This included a picture of the meal of the day to assist residents in choosing what they would like to eat. The records of food were seen and these reflected a varied and balanced diet. A record is completed individually for each resident including a description of how much the person had eaten so that staff are able to monitor residents’ nutritional intake. Comment cards returned by relatives informed that food was generally of a good standard. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well-publicised complaints procedure and the staff being trained in adult protection. EVIDENCE: Due to the mental frailty of the residents, they largely rely upon relatives to make a complaint on their behalf. The complaints procedure for the home is displayed in the main reception area, within the Service User Guide and the terms and conditions of residence. Relatives are given a copy of the Guide and very often they sign the contract and so they are well informed of how to make a complaint should they feel a need. The complaints procedure complies with the format detailed within the standards for older people. Since the time of the last inspection there have been no complaints made to the management of the home and none have been brought to the attention of CSCI. There has been one concern raised by the Coroner concerning the death of a resident following an unfortunate accident within the home. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 15 All of the staff receive training in the protection of vulnerable adults as part of their induction and they are then given further training at a later date through an external trainer. The home has all copies of policies and procedures relating to adult protection. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a suitable, well-maintained, clean and homely environment EVIDENCE: The home is located in a quiet residential area close to the amenities of Westbourne the home has car parking at the front of the building for staff and visitors. As part of the inspection, a tour of the premises was made and the home was found to be in good decorative order, was clean and there were no adverse odours. Due to the mental frailty of the residents, the front door of the home is kept locked to protect residents from wandering and getting lost from the home. All of the radiators have been covered to protect residents Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 17 from burns and thermostatic mixer valves have been fitted to the hot water outlets of baths to protect residents from scalding water. The home has a dedicated laundry room sited away from the two main buildings and is equipped with four commercial washing machines and three commercial drivers. Two laundry staff are employed at the home. The laundry room has a washable floor and washable wall surfaces and hand washing facilities are also provided. Staff are provided with protective clothing and gloves, and were observed to be using these appropriately during the inspection. Alcohol gels are also supplied to the staff. All of the staff are trained in infection control. The home has a sluice for the washing of commodes. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from staffing levels that meet their needs and from staff being recruited appropriately and their being well trained. EVIDENCE: The manager informed that the home of provides the same staffing levels as at the time of the last inspection with seven care staff on duty between 8 a.m. to 2 p.m., six staff between 2 p.m. and 8 p.m. and four staff on awake night duties between 8 p.m. and 8 a.m. The duty roster was displayed in the office this reflected the above staffing levels. In addition to the care staff, the home employs a registered manager, deputy, and an administrator, cooks, cleaners and laundry staff. A duty on-call manager is available to support staff out of office hours. The service manager together with the manager evaluates and monitors staffing levels in line with the Residential Forum guidance. Since the last inspection there has been some changeover of staff. A new deputy manager has been appointed as well as new care staff. During the inspection five members of staff were spoken with about their experience of Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 19 working within the home. From these conversations it appeared that there was good staff morale with staff say they enjoyed working at the home. The recruitment records of two new staff recruited since the time of the last inspection were seen. It was found that all the checks and records required under Schedule 2 of the Regulations had been complied with. These included work permits, a check against the list of people deemed unsuitable to work with vulnerable adults, a criminal record bureau check, two references, proof of identity and a health declaration. It was recommended that the home amends the application form being completed by new staff as this did not request information in line with changes to the Regulations, such as one of the references being from the last position where the applicant worked with vulnerable adults or children. Concerning staff training, at the last inspection 45 of the staff team had completed NVQ level 2 or above. The manager informed that due to staff changes there were now only 12 of staff trained to this level. The manager informed however, that some of the new staff were trained as nurses within the country of origin and may be deemed to be trained to NVQ level 3. It was agreed that the manager would investigate whether these staff qualifications were equivalent to NVQs, which may mean the home has a higher level of staff trained to NVQ level 2. All new staff have induction training that is compliant with skills for care standards. A training chart in the office was seen for all the staff and there was evidence that the management was monitoring staff training. All staff receive training in core areas such as health and safety, first aid, moving and handling, principles of care, fire safety, infection control, and abuse. Since the last inspection all the staff have now been trained in how to care of the people with dementia from an outside trainer. The staff spoken with reported that they received good levels of training from the organisation. The manager also reported that the home had joined the Alzheimers disease Society from whom they get upto-date information and training is also available. It was recommended that training is organised concerning the Mental Capacity Act 2005 and more training is offered for end of life care. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the home being well managed and it being run with residents’ interests in mind. EVIDENCE: Mrs Phillips, the registered manager informed that she was still studying for a Registered Managers Award and that she will then go on to complete NVQ level 4 in care. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 21 At the time of inspection the service manager for the organisation was visiting the home. Visits and reports required by regulation 26 take place and a copy of the report is sent to CSCI. The manager informed that after these visits a plan is made out on how things identified at the time of the visit will be taken forward and actioned. The service manager informed that audits also take place of care plans and other required documentation. Currently an audit was taking place of all the furniture in the home with a view to renewals and replacements. The home carries out an annual quality assurance survey that involves relatives and professionals who have contact with the home. The manager informed that there was an open door policy for residents or relatives to raise issues or concerns with the management. The home does not take responsibility for looking after any money of any residents. It was noted from the dataset sent to CSCI prior to the inspection that the home did not have a policy or an emergency admission under the mental health act 1983. It was agreed that one would be written as the home is registered to admit to people with mental health difficulties. Concerning health and safety there were no obvious hazards identified during the inspection. Risk assessments were seen concerning the building, such as one carried out in June of this year concerning the patio slabs. Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/a X X 3 Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation Schedule 3 (3) (i) Requirement You are required to ensure that records are fully maintained of all medications administered to residents. Timescale for action 17/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP28 OP29 Good Practice Recommendations It is recommended that the home continues working to achieve a ratio of 50 of staff trained to NVQ level 2. It is recommended that the staff application form be amended to request information required by Regulations; such as seeking a reference relating to a person’s last period of employment, which involved work with children or vulnerable adults, of not less that three months duration. It is recommended that the home develop training for the staff concerning end of life care and also The Mental Capacity Act 2005. 3. OP30 Avonwood Manor DS0000043057.V346783.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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